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Clinicians are cautioned to respect the fact that when an individual with a brain injury attempts a purposeful action, the movement pattern that emerges reflects the best that can be done under the circumstances, given the state of all of both the neural and musculoskeletal systems and the dynamic possibilities inherent in the linkages between all the subsystems involved in movement production and control (Carr & Shepherd, 1998). It is the clinician’s task, responsibility, and opportunity to assist the patient/client in developing creative but individual solutions to movement problems given the strengths and challenges of that unique person.

Cornerstone Concepts

  • Differentiation between positive and negative features of brain damage and primary and secondary impairments

  • Abnormal force production: definition, description, and clinical management

  • Weakness

  • Muscle tone abnormalities: abnormally low or abnormally high muscle tone

  • Coordination problems: definition, description, and clinical management

  • Muscle activation and sequencing problems

  • Timing problems

  • Involuntary movements

  • The nature of functional movement problems in individuals with neurological impairment

When faced with what appears to be a large problem, one of the strategies employed in attempts to problem solve is to try to step back from the problem, gain some perspective, and attempt to see the large (seemingly insurmountable) problem as a set of mini-problems or series of interrelated parts. An analysis of the smaller mini-problems, as well as an understanding of how these parts contribute to the whole issue, helps the problem solver to develop and enact a workable solution.

Clinical Connection:

For example, imagine that you are faced with the task of cleaning your apartment, house, or dormitory room. On initial inspection, the entire problem appears to be large and perhaps overwhelming. There are apparent (hard to miss) signs of disarray and disorganization all around you! Some of the “symptoms” of your disarray may be very obvious, others more apparent only in the limitations they contribute to (e.g., “I can’t find my keys!”). Some of these signs of disarray may be the presence of trash and dirt, piles of papers, books, compact discs, and personal belongings, and perhaps even the presence of a persistently obnoxious odor that probably accompanies last week’s late night snack. These signs of your lack of domesticity are very apparent to the naked eye (and nose!). Other symptoms or signs of your domestic disorder may include your inability to find things, an apparent lack of organization for proper storage of needed items, and the frustration you feel when trying to locate your class syllabus, checkbook, or car keys. These signs of your lack of domesticity are not necessarily easy to see, but they unmistakably contribute to your limited ability to function best within your dormitory world.

To solve your functional dilemma, the first thing that you have to do is develop a plan. The plan probably will include ...

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